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Cancer Center Volume and Type Impact Stage-Specific Utilization of Neoadjuvant Therapy in Rectal Cancer

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Abstract

Background

Neoadjuvant chemoradiation reduces local recurrence in locally advanced rectal cancer, and adherence to national and societal recommendations remains unknown.

Objective

To determine variability in guideline adherence in rectal cancer treatment and investigate whether hospital volume correlated with variability seen.

Design

We performed a retrospective analysis using the National Cancer Database rectal cancer participant user files from 2005 to 2010. Stage-specific predictors of neoadjuvant chemotherapy and radiation use were determined, and variation in use across hospitals analyzed. Hospitals were ranked based on likelihood of preoperative therapy use by stage, and observed-to-expected ratios for neoadjuvant therapy use calculated. Hospital outliers were identified, and their center characteristics compared.

Results

A total of 23,488 patients were identified at 1183 hospitals. There was substantial variability in the use of neoadjuvant chemoradiation across hospitals. Patients managed outside clinical guidelines for both stage 1 and stage 3 disease tended to receive treatment at lower-volume, community cancer centers.

Conclusions

There is substantial variability in adherence to national guidelines in the use of neoadjuvant chemoradiation for rectal cancer across all stages. Both hospital volume and center type are associated with over-treatment of early-stage tumors and under-treatment of more invasive tumors. These findings identify a clear need for national quality improvement efforts in the treatment of rectal cancer.

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Authors and Affiliations

  1. Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, OH, USA

    Emily F. Midura, Andrew D. Jung, Meghan C. Daly, Dennis J. Hanseman, Bradley R. Davis, Shimul A. Shah & Ian M. Paquette

  2. Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Cincinnati, OH, USA

    Emily F. Midura, Andrew D. Jung, Meghan C. Daly, Dennis J. Hanseman, Shimul A. Shah & Ian M. Paquette

  3. 2123 Auburn Avenue, #524, Cincinnati, OH, 45219, USA

    Ian M. Paquette

Authors
  1. Emily F. Midura
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  2. Andrew D. Jung
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  3. Meghan C. Daly
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  4. Dennis J. Hanseman
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  5. Bradley R. Davis
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  6. Shimul A. Shah
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  7. Ian M. Paquette
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Contributions

EFM contributed to study design, acquisition of data, analysis of data, and drafting the article, approval of the final version; ADJ contributed to critical revisions, and approval of the final version; MCD contributed to acquisition of data, analysis of data, critical revisions, and approval of the final version; DJH contributed to acquisition of data, analysis of data, critical revisions, and approval of the final version; BRD contributed to study design, analysis of data, critical revisions, and approval of final version; SAS contributed to study design, analysis of data, critical revisions, and approval of final version; IMP contributed to study design, acquisition of data, analysis of data, drafting of manuscript, revisions, and approval of final version.

Corresponding author

Correspondence to Ian M. Paquette.

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Conflict of interest

No author has any conflict of interest to report.

Additional information

Disclaimer The data used in the study are derived from a de-identified NCDB file. The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology employed, or the conclusions drawn from these data by the investigator.

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Midura, E.F., Jung, A.D., Daly, M.C. et al. Cancer Center Volume and Type Impact Stage-Specific Utilization of Neoadjuvant Therapy in Rectal Cancer. Dig Dis Sci 62, 1906–1912 (2017). https://doi.org/10.1007/s10620-017-4610-2

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  • DOI: https://doi.org/10.1007/s10620-017-4610-2

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